Necrotizing Soft Tissue Infection of the Breast: A Unique Presentation of Underlying Invasive Breast Cancer

Abstract

Necrotizing soft tissue infections (NSTIs) are life-threatening infections that most commonly affect the extremities, perineum, and abdominal wall. These infections begin with the presence of toxin-producing bacteria that invade through a defect in the skin barrier, such as a wound, laceration, trauma, or recent surgical incision. These bacteria cause subsequent tissue destruction and necrosis that can involve the superficial skin, subcutaneous tissue, fascia, and/or muscle. NSTIs can progress quickly, leading to severe sepsis, shock, and even death. NSTIs associated with the breast are an exceedingly rare occurrence, requiring early diagnosis and prompt surgical intervention. In this article, we report the case of a 46-year-old woman with an NSTI of the left breast, which required serial debridement initially, and subsequently a modified radical mastectomy given a pathological diagnosis of invasive ductal carcinoma.

Keywords: breast cancer; critical care; invasive ductal breast carcinoma; necrotizing soft tissue infection; sepsis; surgical oncology.

Figure 1. Presentation of the left breast

Figure 2. Index CT showing deep mass, which is partially covered by the pectoralis major muscle. Adjacent pathologic nodes just lateral to the pectoralis minor muscle are visible. The mass itself measured radiographically close to 5.3 x 5.3 cm

CT: computed tomography

Figure 3. Image before mastectomy, after serial debridements and negative pressure therapy

Figure 4. Left mastectomy specimen